Many professional and family
caregivers deem increasing the amount of prescription
pain medication, for chronically ill people in pain, an
unacceptable act. Terminally ill people are literally
dying with an unnecessary amount of pain because of the
negative stigma attached to administering surplus
pain-killing opioids when needed. Many family caregivers
and medical personnel are under the notion that upping
doses of painkillers can be fatal. In addition, some
believe pain medications like opioids, are a narcotic
that is extremely addictive and includes heavy side
effects. But, a new survey published in the July 29,
2000 issue of The Lancet suggests, “Increasing use of
pain-killing opioids such as morphine in terminally ill
patients does not shorten life.”

Researchers reviewed the cases 238 patients who died
during palliative care in their institutions. The study
was prompted by public and professional concern that the
use of opioids for symptom control might shorten life.
They retrospectively analyzed the pattern of opioid use
in the last week of life; the daily doses were low.
However, marked increases in opioids at the end of life
did not significantly influence survival, frequency of
unexpected death, or description of death.

The study challenges the myth that proper pain control
for end-of-life care means killing the patient.
According to Sandra Johnson, former president of the
American Society of Law, Medicine and Ethics and expert
in the area of health law, pain management and care for
the elderly, “The problem is many people believe that
pain medication, like opioids, are addictive and have
terrible side effects. The fact is, the risk of
addiction for someone who is receiving end-of-life care,
is irrelevant and side effects aren’t severe and
eventually clear up.” Some of the side effects
attributed to opioids include constipation, blurred
vision and lethargy and eventually, a person’s body will
become acclimated to them.

Part of the problem in nursing and medical education is
that much of the research on the effectiveness and
safety of pain management is relatively recent and
contradicts common knowledge of earlier pain control
practices. Some professionals in the medical community
think proper palliative or comfort care is euthanasia
under a different name. In the Lancet report, Drs.
Andrew Thorns and Nigel Sykes of St. Christopher’s
hospicee in London said, “There is no connection between
competent symptom control and euthanasia. It is possible
to achieve good symptom control by using morphine
competently, and you do not shorten people’s lives when
you do that.” Also, physicians feel threatened by legal
sanctions for treating patients in pain especially when
the treatment relies on the use of controlled
substances. The report recommends that if a doctor is
seriously concerned about shortening a patient’s life,
they should consult a specialist in the field of
palliative care.